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At least 19 recordsLinked to original sources

PubMedDate not supplied

Parental attitudes about a pregnancy predict birth weight in a low-income population.

BACKGROUND: Low birth weight remains the primary cause of neonatal morbidity and mortality in the United States. We examined whether maternal happiness about a pregnancy, in addition to her report of the father's happiness, predicts birth weight and risk for low birth weight (<2,500 g). METHODS: In this prospective cohort study, the mother's report of her and her partner's happiness about the pregnancy was measured before 21 weeks' gestation on a scale from 1 to 10 (1 to 3 unhappy, 4 to 7 ambivalent, or 8 to 10 happy). "Mother reports partner happier" occurred when the mother perceived the father's happiness score at least 5 points greater than her own. Information on birth weights and maternal sociodemographic, medical, and psychosocial factors were obtained from surveys and medical records. RESULTS: Of 162 live births, 9 were low birth weight (5.6%). Compared with women who reported happiness with the pregnancy, risk for low birth weight was greater when the mother reported partner happier about the pregnancy (relative risk 10.0, 95% confidence interval, 3.1-32.4). This predictor of birth weight remained significant in multivariate linear regression analyses (coefficient = -472 g, SE = 171 g, P = .007) after adjustment for other known predictors of birth weight. CONCLUSIONS: Maternal report of greater partner happiness about a pregnancy is associated with birth weight and appears to define low- and high-risk subgroups for low birth weight in a low-income population. Further study in larger samples is needed to confirm our findings and to assess whether maternal report of greater partner happiness is itself a modifiable factor or is a marker for other factors that might be modified with targeted interventions.

Adolescent↗

PubMed1999

Increasing response rates for mailed surveys of Medicaid clients and other low-income populations.

Mailing surveys to low-income populations is often avoided because of concern about low response rates. In this study, the authors used a mailed survey of a low-income population to test whether $1.00 or $2.00 cash-response incentives were worth the expense and whether 2-day priority mail ($2.90 postage) would yield a sufficiently higher response rate than certified mail ($1.52 postage) to justify its cost. In 1994, 2,243 randomly selected families in subsidized health care programs in Pierce County, Washington, were randomly sent no incentive, $1.00, or $2.00 in the first of three mailings. For the third mailing, nonrespondents were randomly assigned to receive either certified or 2-day priority mail. After 4 weeks, the response rates were 36.7%, 48.1%, and 50.3% for the no-incentive, $1.00, and $2.00 groups, respectively. After three mailings, the cost per response was the lowest for the group that received $1.00. The response rate for the certified mailing (28.1%) was significantly higher than the rate for the more expensive priority mailing (21.7%). No incentive-related bias was detected. The authors concluded that the most efficient protocol for this low-income population was to use a $1.00 incentive in the first mailing and a certified third mailing.

Aged↗

PubMed1995

Delaying the introduction of complementary food until 6 months does not affect appetite or mother's report of food acceptance of breast-fed infants from 6 to 12 months in a low income, Honduran population.

Low income, primiparous mothers who had exclusively breast-fed for 4 mo were randomly assigned to one of three groups: 1) continued exclusive breast-feeding to 6 mo (EBF), 2) introduction of complementary foods at 4 mo, with ad libitum nursing 4-6 mo (SF), and 3) introduction of complementary foods at 4 mo, with maintenance of base-line nursing frequency 4-6 mo (SF-M). After the intervention phase (4-6 mo; n= 141), home visits were conducted for a subsample at 9 (n = 60) and 12 (n = 123) mo. At each visit, an observer recorded infant food intake at the midday meal and interviewed the mother regarding usual feeding patterns and the infant's acceptance of 20 common food items. All but two infants (1.5%) were breast-fed to 9 mo and all but eight (6%) to 12 mo. There were no significant differences among groups in breast-feeding frequency, amount or number of foods consumed at the midday meal, percentage of food offered that was consumed, usual daily number of meals and snacks, number of food groups consumed, or overall food acceptance score. Frequency of consumption of foods from eight different food groups (dairy, meats, eggs, grains, beans, fruits, vegetables, tubers) was not significantly different among groups except that, at 9 mo only, the SF group (but not the SF-M group) consumed more vegetables than did the EBF group. These results indicate that delaying the introduction of complementary foods until 6 mo does not adversely affect appetite or food acceptance among breast-fed infants.

Adolescent↗

PubMed2001

5 a day fruit and vegetable intervention improves consumption in a low income population.

OBJECTIVE: This study evaluated the Michigan Farmers' Market Nutrition Program in one Michigan county to determine its effect on fruit and vegetable consumption behavior. SUBJECTS/SETTING: Subjects were selected from WIC and Community Action Agency populations: 564 low income women completed the pretest; 455 completed the posttest. Attrition rate was 19.3%. INTERVENTION: Subjects were assigned to one of 4 interventions: education about the use, storage and nutritional value of fruits and vegetables, distribution of farmers' market coupons, both education and coupons, or no intervention. DESIGN: Education-only and coupon and education groups were randomly assigned; clinic appointment timing determined assignment to no-intervention and coupon-only groups. MAIN OUTCOME MEASURES: A self-administered questionnaire before and after intervention measured attitudes about fruit and vegetable consumption and intake of fruits and vegetables. WIC records documented redemption of coupons. STATISTICAL ANALYSES: Data analysis included 2-way multivariate analysis of covariance, univariate analysis of covariance, logistic regression, and covariance structure modeling. RESULTS: Both the education interventions and the coupon interventions had positive effects. Coupons had a direct effect on increasing fruit and vegetable consumption behavior but no effect on attitudes. Education had a direct effect on attitudes and seemed to exert an effect on consumption behavior through attitudes. The maximum impact of the intervention was achieved through a combination of education and coupons. APPLICATIONS: This study demonstrated that a low-income population may be more likely to increase its fruit and vegetable consumption behavior when incentives such as coupons improve affordability.

Analysis of Variance↗

PubMed2000

Utilisation rates in capitated primary care centres serving low income populations.

AIM: To measure utilisation rates in capitated primary care organisations serving low income populations with low or zero co-payments, and to examine the relationship between utilisation rates and organisation, age group, sex, ethnicity, community services card (CSC) holding rates, high use health card (HUHC) holding rates and deprivation of area of residence (NZDep96). METHODS: Data were collected during 1997/98, from eleven primary care organisations. Utilisation data were collected from practice computer information systems. RESULTS: 53.9% of registered patients were recorded as having consulted in a twelve-month period. Utilisation rates for doctor, nurse and midwife combined were higher amongst the young, elderly, and CSC holders. For males, they were higher amongst those living in the most socioeconomically deprived areas, but not for females. Utilisation rates were highest amongst the 'other' ethnic group, and lowest in the Pacific Island ethnic group. Organisation, age group, sex, ethnicity, CSC, HUHC and NZDep96 were independently predictive of total utilisation. CONCLUSIONS: Utilisation rates in capitated practices tended to be lower than those in fee-for-service practices. If equitable needs-based capitation funding formulas are to be developed, utilisation data from capitated practices in a range of cultural and socioeconomic settings is urgently required.

Adolescent↗

PubMed2000

Prevalence of the use of herbal products in a low-income population.

OBJECTIVES: This study determined the prevalence of herb/supplement use in a low-income population and determined the providers' level of knowledge about herbs/supplements. METHODS: Adult English-speaking patients seen at a rural family practice residency clinic were offered an anonymous survey. Another survey was developed for the clinic providers. Data were analyzed using the chi-square test. RESULTS: Fifty-six percent of a low-income population use herbs/supplements; 41% of all users cited friends or relatives as their main source of information, and 53% of users had not informed their provider. In the provider survey, 69% of the providers indicated that they had received no education about herbs/supplements, yet 71% were asked about them by patients at least twice a month. CONCLUSIONS: Because herb/supplement use occurs across all demographic groups, all patients should be questioned about their use of such substances. Currently, few providers are prepared to guide their patients about herbs/supplements. Efforts should be made to educate health care providers about common herbs/supplements.

Adolescent↗

PubMed2003

Variability in asthma care and services for low-income populations among practice sites in managed Medicaid systems.

OBJECTIVE: To characterize and describe variability in processes of asthma care and services tailored for low-income populations in practice sites participating in Medicaid managed care (MMC). STUDY SETTING: Eighty-five practice sites affiliated with five not-for-profit organizations participating in managed Medicaid (three group-model health maintenance organizations [HMOs] and two Medicaid managed care organizations [MCOs]). STUDY DESIGN/DATA COLLECTION: We conducted a mail survey of managed care practice site informants using a conceptual model that included chronic illness care and services targeting low-income populations. The survey asked how frequently a number of processes related to asthma care occurred at the practice sites (on a scale from "never" to "always"). We report mean and standard deviations of item scores and rankings relative to other items. We used within-MCO intraclass correlations to assess how consistent responses were among practice sites in the same MCO. PRINCIPAL FINDINGS: Processes of care related to asthma varied gready in how often practice sites reported doing them, with information systems and self-management support services ranking lowest. There was also significant variation in the availability of services targeting low-income populations, specifically relating to cultural diversity, communication, and enrollee empowerment. Very little of the site-to-site variation was attributable to the MCO. CONCLUSIONS: Our conceptual framework provides a means of assessing the provision of chronic illness care for vulnerable populations. There is room for improvement in provision of chronic asthma care for children in managed Medicaid, particularly in the areas of self-management support and information systems. The lack of consistency within MCOs on many processes of care suggests that care may be driven more at the practice site level than the MCO level, which has implications for quality improvement efforts.

Asthma↗

PubMedDate not supplied

Race differences in the proportion of low birth weight attributable to maternal cigarette smoking in a low-income population.

PURPOSE: To quantify race differences in the public health impact of maternal cigarette smoking on infant birth weight and to estimate the proportion of low birth weight births that could be prevented by maternal smoking cessation. DESIGN: A cohort that consisted of 77,751 mother-infant pairs was evaluated retrospectively. SETTING: Statewide study of Women, Infants and Children participants in North Carolina. SUBJECTS: African-American and non-Hispanic white women who delivered a single live infant during 1988, 1989, or 1990. MEASURES: Logistic regression estimates of the relative risk of low birth weight births for smokers were used to calculate adjusted population attributable risk percentages for smoking. Separate population attributable risk percentages were calculated for total low birth weight, moderately low birth weight, and very low birth weight, and all estimates were adjusted for prepregnancy body mass index, gestational weight gain, age, education, parity, and timing of entry into prenatal care. RESULTS: Non-Hispanic whites had a much higher prevalence of smoking and were heavier smokers than African-Americans. For both moderately low birth weight and very low birth weight, the population attributable risk percentages for smoking were twice as high for non-Hispanic whites than for African-Americans. Overall, after adjustment, 30.7% of low birth weight births among non-Hispanic whites and 14.4% of low birth weight births among African-Americans were attributable to smoking. CONCLUSIONS: Although the public health impact of maternal cigarette smoking on infant birth weight was twice as high for non-Hispanic whites as for African-Americans in this low-income population, smoking cessation by all low-income pregnant women would result in significant improvements in infant health and well-being.

Adult↗

PubMed1983

Applicability of the Denver Prescreening Developmental Questionnaire in a low-income population.

A prospective study was conducted to assess the applicability of the Denver Prescreening Developmental Questionnaire (DPDQ) in a predominantly black, low-income population in Mobile, Alabama. The effect of an educational intervention designed to increase the accuracy of parental responses to the DPDQ was also assessed. In a longitudinal follow-up program, 127 infants aged 2 weeks to 1 year were recruited. Parents in a randomly selected experimental group observed an audio-visual presentation describing progressive developmental behaviors, received handout materials summarizing these behaviors, and were asked to record their child's subsequent attainment of these behaviors. Mean agreement scores, obtained by comparing parental responses to the DPDQ with the corresponding items of the Denver Developmental Screening Test (DDST), did not differ between the experimental and control groups. These scores showed agreement of 93.6% (3-month visit), 91.3% (6-month visit), 91.6% (9-month visit), and 95.1% (12-month visit), resulting in an overall mean agreement score of 92.9%. The overreferral rate was low (13%) and no underreferrals were obtained. These results attest to the applicability of the DPDQ in low-income population and demonstrate the lack of effectiveness of the educational intervention in increasing the accuracy of parental responses to the DPDQ.

Adolescent↗

PubMed1995

Dental care satisfaction: the reliability and validity of the DSQ in a low-income population.

OBJECTIVES: Studies examining satisfaction with dental health care among the poor are quite rare. This study was done to confirm the internal structure and reliability of the Dental Satisfaction Questionnaire (DSQ), a measure of dental care satisfaction, among a low-income population, and provide normative data regarding dental satisfaction among low-income people. METHODS: Subjects were 895 mothers of school-aged children who were administered the DSQ as part of a larger study of dental utilization and dental fears in Seattle. RESULTS: Factor analysis largely confirmed the factor structure of the DSQ. Results also suggested subjects in this sample were less satisfied with pain management than nonpoor people. Self-reported dental health and dental appearance were associated with satisfaction with pain management, quality of care, access to care, and overall satisfaction. Race/ethnicity, education level, marital status, nation of origin, and type of insurance predicted differences in satisfaction with pain management and access. CONCLUSIONS: Barriers to dental care and quality of care among low-income populations are discussed. Uses and research with the DSQ are suggested.

Attitude to Health↗

PubMed1996

Determinants of dental user groups among an elderly, low-income population.

OBJECTIVE: We test whether or not there are differences for selected variables among five dental user groups and one nondental group within an elderly, low-income population. DATA SOURCE: We used ten years of Medicare Part B claims data from the Cincinnati Health Department for all clinic users 62 years of age and older who participated in the Municipal Health Services Program. STUDY DESIGN: A polychotomous logistic regression model determined the ability to differentiate between the groups for each of the selected variables, controlling for race. Next, a polychotomous stepwise logistic regression was used in finding a multivariate model for determining dental user group membership. Logistic regression was used to ascertain which variables were discriminators between any two types of dental users. PRINCIPAL FINDINGS: Mean number of medical visits, mean number of prescriptions filled, and race are determinants of group membership, with the nondental group having more medical visits and more likely to be white. Although year of birth cohort is statistically significant in determining dental user types, the direction of effect is not constant across the comparisons. However, the relative risk for being in the two complete denture groups, compared to both compliant subgroups, increases with each older cohort. CONCLUSIONS: Higher levels of medical use may "crowd out" dental use, even when it is without user cost, either because the medical problems are treated as a higher priority, or because dealing with medical needs leaves too little perceived time or energy to seek dental care. Even in a low-income population seeking dental care, there appears to be a birth cohort effect with a decline in the younger elderly who require two complete dentures.

Aged↗

PubMed2005

[Low rate of achieving LDL-cholesterol objective in a low income population].

OBJECTIVE: To assess the percentage of patients suitable to the objectives preconized by III Diretrizes sobre Dislipidemias da Sociedade Brasileira de Cardiologia (3rd Guidelines on Dyslipidemia of Brazilian Society of Cardiology), in a low income population. To determine whether there was a difference of that percentage in high risk patients, according to their age (< 75 years old vs. > 75 years old). METHODS: We analyzed, consecutively, 190 patients, divided in two groups: 51 low and middle risk patients (G I) and 139 high risk patients for coronary artery disease (G II). The sample was characterized by low income patients (69% for the patients had a family income between 1 and 2 minimum salaries), whose hypolipidemic therapy was irregularly supplied by the state. RESULTS: G I and G II showed, respectively, 70.1 +/- 13.7 years old and 13.7% of men and 68.5 +/- 10.6 years old and 62.6% of men. Among patients from G II, 30% showed LDL-cholesterol within the preconized objectives. The frequency of patients suitable to the objectives was significantly lower in individuals with 75 years of age or older than among those younger than 75 years old (16% vs. 30%, p = 0.04). CONCLUSION: In a predominantly low income population and without continuous assistance from the State to purchase statins, the achievement of preconized objectives for LDL-cholesterol, by 3rd Guidelines on Dyslipidemia of Brasilian Society of Cardiology, is low and also significantly lower among very old patients, with a high risk profile for atherosclerosis.

Age Distribution↗

PubMedDate not supplied

[Living conditions and gastroenteritis in the low income population of Tijuana, Mexico].

A cross-sectional study was carried out in the low income population of certain areas of the city of Tijuana, Mexico. Data collected showed that these suburban areas are inhabited by people from rural areas of Mexico, with minimum education, that basically work at the "maquiladoras". General hygienic conditions were poor and the services insufficient. The prevalence of diarrheas among the population was extremely high in the two weeks previous to the study, being highest for children less than one year old, in which the proportion with at least one episode of diarrhea was 47 per cent.

Adolescent↗

PubMedDate not supplied

Managed care and low-income populations: recent state experiences.

This DataWatch examines the relationship between managed care enrollment and access to care for low-income adults with Medicaid and compares their experience with that of low-income, privately insured managed care enrollees. Medicaid managed care enrollees are more likely than low-income, privately insured managed care enrollees to be poorer, have health problems, and experience access problems. Compared with low-income populations in fee-for-service care, managed care enrollees, whether in Medicaid or privately insured, are not appreciably different in having a usual source of care, having a regular provider, or emergency room use but report more problems in obtaining care and are more likely to be dissatisfied with their health plans.

Adult↗

PubMed2001

[Sickness risk coverage of the poor and low income population].

Among regimes of sickness risk coverage, those who are managed by the government to the profit of the poor and low income population offer advantages in nature, in the form of total exempt from payment or a strong subsidy of care in public sanitary structures of the ministry of public health. These two regimes, known as "Gratuitous Medical Assistance", existed under other names since the 1950's and has undergone various modifications that had all for objective to adapt the benefit of the gratuitous of care to the economic conditions and financial of the targeted population.

Health Care Reform↗

PubMedDate not supplied

Contraceptive risk-taking in a medically underserved, low-income population.

This study examines the phenomenon of contraceptive risk-taking, which is the nonuse of contraception by women who are sexually active, fertile and not pregnant or trying to become pregnant. Based on a survey sample of low-income women in their childbearing years who had not received family planning care or advice from a doctor or clinic for at least three years, the study analyzed demographic predictors of contraceptive risk-taking and also compared levels of contraceptive knowledge and pregnancy histories of noncontraceptors versus barrier contraceptors. Contraceptive risk-taking was found to be higher for minority women, for parous women, for those age 30 and younger, and for those whose knowledge of the fertility cycle is incorrect, but risk-taking was found to be unrelated to the women's marital status. Noncontraceptors were less knowledgeable concerning contraceptive methods and substantially more likely to have had previous unwanted pregnancies due to nonuse of contraception, suggesting that current contraceptive risk-taking probably represents a relatively enduring feature of reproductive behavior for a subgroup of the medically undeserved low-income population.

Adolescent↗

PubMed1986

Serological evaluation of poliomyelitis oral and inactivated vaccines in an urban low-income population at Rio de Janeiro, Brazil.

Oral and inactivated poliomyelitis vaccines (OPV and IPV), were given to 160 children two months old, in a low income population at Rio de Janeiro. The vaccination was repeated 2 and 4 months later, always in association with diphtheria, tetanus and pertussis (DPT) vaccine. Blood specimens were collected before vaccination at the time of the third dose of vaccine and later at the time of measles vaccination, when the children were nine months old. The serological response to two doses of IPV showed high titres of antibody in all but one child and 100% conversion after three doses. Although poliomyelitis has been controlled in Brazil by the use of OPV in large mass campaigns, the results obtained with IPV support the possibility of its use in the basic immunization schedule, providing lower costs could be achieved for the inactivated vaccine.

Antibodies, Viral↗

PubMed2003

Food consumed does not account for the higher prevalence of obesity among stunted adults in a very-low-income population in the Northeast of Brazil (Maceió, Alagoas).

OBJECTIVE: To study the food pattern of stunted and nonstunted, obese and nonobese individuals in a very-low-income population. DESIGN: A household survey. SETTING: Slum set up by the 'Homeless Movement', city of Maceió (Alagoas), Brazil. SUBJECTS AND METHODS: A total of 532 adults classified by sex, stature (Z</= and Z > -2s.d. of the NCHS curves), and body mass index (BMI) were compared using the following variables: waist circumference, waist-hip circumference ratio (W/H), percentage body fat (skinfold thickness and bioelectrical impedance), and food intake (24-h recall). RESULTS: The prevalence of stunting was 22.6%. In all, 30% of the stunted subjects were overweight or obese, compared with 23% for the nonstunted individuals (P<0.05). In women, logistic regression analysis showed a strong association among weight, abdominal fat, and stunting (r=0.81). No significant differences were observed in the values of W/H or in the qualitative menu of the different categories. Energy intake was below the RDA figures (about 63%). There was similarity among the groups regarding the proportion of macronutrients, except for the fact that stunted obese women ingested less fat and protein than nonstunted obese women. Stunted obese individuals consumed less energy (5962 kJ) than the population as a whole (6213 kJ), an amount far lower than their average needs, which were calculated on the basis of their shorter stature (8109 kJ). CONCLUSION: The observed energy consumption seems compatible with the panorama of undernutrition present in the population, but it does not explain the high prevalence of obesity detected.

Adult↗